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Biomedical subjects

D F Archer

Publications and source records attributed to D F Archer.

At least 73 records · Page 4Linked to original sources
PubMed1990

The relationship between serum estradiol-17 beta concentrations and induced pituitary luteinizing hormone surges in postmenopausal women.

The present study was designed to evaluate the effect of different serum concentrations of estradiol-17 beta (E2) on pituitary luteinizing hormone (LH) release in postmenopausal women. Serum E2 levels were evaluated in healthy postmenopausal women while they wore two, four, and six transdermal E2 delivery systems. The mean serum E2 levels at 48 hours after application of the devices were 185.5, 338.9, and 520.5 pg/mL, respectively, which were significantly different from each other. Serum E2 levels were stable throughout the first 48 hours of patch application but declined by a mean of 54% between 48 and 72 hours. Pituitary LH surges were induced with all three serum concentrations of E2 but were present more often with the higher serum values. There were no significant differences between the mean interval of device utilization and initiation, height, or duration of the induced pituitary LH surge at any of the three serum E2 concentrations studied.

Adult↗
PubMed1989

Effects of clomiphene citrate on episodic luteinizing hormone secretion throughout the menstrual cycle.

Pituitary luteinizing hormone secretory dynamics (pulse frequency and amplitude) were evaluated in eight normal women administered clomiphene citrate or placebo. After 5 days of treatment clomiphene citrate was found to increase mean luteinizing hormone secretion by increasing the amount of pituitary luteinizing hormone released per pulse. No change in pituitary luteinizing hormone interpulse interval was found in the follicular phase of the cycle, although a faster pulse frequency in the luteal phase was found after clomiphene citrate when compared with placebo. No differences were found in the luteal phase (pulse frequency, amplitude, and mean luteinizing hormone level) after clomiphene citrate versus placebo in the volunteers. These data suggest that the principal mechanism of action of clomiphene citrate is an increase in the concentration of hypothalamic gonadotropin releasing hormone into the hypothalamic-pituitary portal circulation, with a resultant increase in pituitary luteinizing hormone secretion.

Adult↗
PubMed1988

Ovarian follicular maturation in women. II. Reversal of estrogen inhibited ovarian folliculogenesis by human gonadotropin.

The current study was undertaken to investigate the role of follicle-stimulating hormone (FSH) in reversing estrogen-induced follicular atresia. Normal menstruating women received ethinyl estradiol (EE2) 50 micrograms/day orally from days 2 to 7 after the onset of menses. Concomitant intramuscular injections of 1.0 ml of saline were administered to group 1, 75 IU of FSH and luteinizing hormone (LH) to group 2, and 150 IU units of FSH and LH to group 3. Daily blood samples were obtained throughout the investigative cycle for FSH, LH, 17 beta-E2, and progesterone. The women in group 1 had evidence of follicular atresia and a significant reduction in serum FSH and LH when compared to group 3 (P less than 0.002 and less than 0.001 respectively). Ovarian follicular development was maintained in groups 2 and 3, based on ultrasound evidence and the interval from menses to midcycle LH surge. These data indicate that the exogenous administration of FSH and LH results in maintenance of ovarian follicular development in women treated with exogenous estrogen.

Body Temperature↗
PubMed1987

Prolactin response to thyrotropin-releasing hormone in women with infertility and/or randomly elevated serum prolactin levels.

Infertile women with normal serum prolactin (PRL) levels have been known to establish a pregnancy after the use of bromocriptine, a dopamine agonist. These data imply that there may be a group of women with a slight but significant increase in PRL secretion that may have resulted in their infertility. This study evaluates the thyrotropin-releasing hormone (TRH)-induced PRL and thyroid-stimulating hormone (TSH) response in normal women (NL, n = 6), women with anovulation and/or inphase endometrial biopsies (AN/IN, n = 12), and women with histologic evidence of luteal phase deficiency (LPD, n = 12). Most of these women were found to have elevated serum PRL values on random testing. There was a statistically significant increase in PRL response at all time intervals after TRH between the NL and AN/IN groups compared with the group with LPD on the basis of repeated measures analysis (P = 0.0013). There was no statistical difference in the TSH response between these three groups. Although the PRL response was statistically different, individual PRL response patterns were not diagnostic. It appears from these data that there is an increased PRL secretion in infertile women who have histological evidence of a LPD.

Adult↗
PubMed1987

Effect of exogenous luteinizing hormone-releasing hormone on hypothalamic pituitary function in women with ovarian failure.

Pituitary luteinizing hormone (LH) pulse frequency and amplitude were assessed as an indirect indicator of hypothalamic luteinizing hormone-releasing hormone (LH-RH) release in women with evidence of ovarian failure. Exogenous LH-RH (20 micrograms) was administered intravenously every 2 hours for 48 hours to determine the effect on pituitary LH release and the hypothalamic pulse generator for LH-RH secretion. This study design was used to investigate the possibility of an ultrashort negative feedback of LH-RH upon the synthesis and release of endogenous LH-RH. A wide range of LH pulse frequencies (8 to 28 pulses/24 hours) was present in these women. There was no discernible inhibition of hypothalamic LH-RH pulse frequency during or following exogenous LH-RH administration. Mean peripheral LH levels were significantly increased during exogenous LH-RH administration (P = 0.0038), reflecting both an increased baseline and an augmented pituitary LH response to the exogenous LH-RH. There were no differences found in LH pulse amplitude before and after LH-RH treatment. These data indicate that pituitary LH secretion in women with ovarian failure can be further stimulated by exogenous LH-RH. However, there was no evidence for inhibition of either pituitary LH secretion or hypothalamic LH-RH release using this administration schedule of exogenous LH-RH.

Adult↗
PubMed1987

Current concepts and treatment of hyperprolactinemia.

The present information relative to hyperprolactinemia is designed to give the reader insight into the possible central abnormalities occurring in women with elevated prolactin levels. It appears that in the presence of elevated prolactin levels appropriate testing should evaluate the pituitary gland, and that this should be performed in association with thyroid function studies. The treatment of high prolactin levels is mainly based on the clinical findings, but in most of the instances, a medical approach utilizing bromocriptine appears to be advantageous. Long-term results appear to indicate that bromocriptine is effective with a wide margin of safety.

Animals↗
PubMed1986

Ovarian follicular maturation in women. I. Intermittent versus daily administration of human menopausal gonadotropin.

This study was designed to compare the efficiency of daily intramuscular human menopausal gonadotropin (hMG) therapy to an intermittent subcutaneous regimen in women with ovulatory dysfunction. Ovarian follicular development was assessed with the use of serial ultrasound scans and serum 17 beta-estradiol (E2) levels. Ovulation was based on pregnancy and/or elevated luteal progesterone values. There were no significant differences between the two treatment regimens, based on E2 levels, follicular size, and/or number of follicles greater than 1.0 cm. Pregnancy and ovulation occurred more frequently after intramuscular hMG therapy. These results indicate that daily hMG is preferred over intermittent subcutaneous administration because of convenience.

Adult↗
PubMed1983

Etiology of recurrent pregnancy losses and outcome of subsequent pregnancies.

Prospective evaluation of 155 couples with two or more consecutive pregnancy losses disclosed uterine morphologic abnormalities in 27%, chromosomal abnormalities in 21 individuals (7.7%, or 15.4% of the couples), and at least one abnormal diagnostic test suggestive of a cause for recurrent pregnancy losses in 106 (68%). A positive test for antinuclear antibody was found in 7.5% of the women, whereas the expected rate in a population of this age is less than 2%. Cervical cultures for Ureaplasma urealyticum (T-strain mycoplasma) were positive in 48% of the women, and 28% of these women had a genetic or uterine abnormality to explain their pregnancy losses. Thyroid function profiles and cervical cultures for Mycoplasma hominis provided no significant information in the evaluation in these couples. With the exception of women with a positive antinuclear antibody, the overall prognosis for later pregnancies was quite good whether the diagnostic evaluation of the couple was normal (77% subsequent live births) or abnormal (71% subsequent live births). The significance of the positive antinuclear antibody in these women is unclear, but further studies and long-term evaluation are necessary to determine the relationship between recurrent pregnancy losses and later development of collagen-vascular diseases.

Abortion, Habitual↗
PubMed1982

Bromocriptine treatment of women with suspected pituitary prolactin-secreting microadenomas.

The present study was designed to investigate the efficacy of bromocriptine in reducing serum prolactin (PRL) levels and in decreasing the size of PRL-secreting microadenomas. Bromocriptine, 5.0 mg, was administered daily for 2 years of 17 women who had galactorrhea, hyperprolactinemia, and hypocycloidal polytomographic evidence suggestive of a pituitary microadenoma. Serum PRL levels were normalized in 16 of 17 women during therapy. Associated with this was resumption of regular menses in 15 of 16 women with menstrual dysfunction and cessation of galactorrhea in 16 of the 17 women. Improvement in the roentgenographic appearance of the sella turcica occurred in two women. No progression in tumor size was found during the course of therapy. Side effects attributed to bromocriptine were minimal, transient, and usually well tolerated. These data suggest that bromocriptine is an appropriate therapeutic modality for PRL-secreting pituitary microadenomas.

Adenoma↗
PubMed1982

A genetic male patient with 17 alpha-hydroxylase deficiency.

A patient with 46,XY karyotype and 17 alpha-hydroxylase deficiency is reported who illustrates marked virilization of the external genitalia. Marked phallic development and almost complete labioscrotal fusion with no development of a utriculovaginal pouch were noted. Because the perineum was essentially similar to that seen in male-to-female transsexuals, vaginal construction required the McIndoe procedure. Hence, although some patients with 17 alpha-hydroxylase deficiency have minimal virilization of the external genitalia, this patient's history indicates the operative management necessary in the opposite extreme, when patients show complete masculinization. Hormonal evaluation after gonadectomy revealed the enzyme deficiency based on abnormalities of steroid secretion by the adrenal cortex.

Adrenal Hyperplasia, Congenital↗
PubMed1981

Validity of hypothalamic-pituitary testing in hyperprolactinemia: prolactin responses to insulin hypoglycemia and arginine.

The release of prolactin (PRL) following insulin tolerance testing (ITT) and arginine infusion was studied in four groups of women: normal volunteers, amenorrheic women with normal PRL levels, and hyperprolactinemic women with and without roentgenographic evidence of pituitary adenoma. Women with normal serum PRL concentrations were found to have an increase in peripheral PRL and both testing modalities. Hyperprolactinemic women, whether or not there was evidence of a pituitary adenoma, did not appear to have a PRL response to either of these tests. Based on the percent change of PRL over basal values, there was a significant difference between the euprolactinemic and hyperprolactinemic groups (p less than 0.01 for insulin and p less than 0.05 for arginine). Our data indicate that in women with hyperprolactinemia neither ITT- nor arginine-induced PRL release can be utilized to discriminate between the presence and absence of an adenoma. This poor PRL response to ITT and arginine in the hyperprolactinemic patients could be the result of hypothalamic dysfunction.

Adenoma↗
PubMed1981

The fallacy of the postpill amenorrhea syndrome.

In conclusion, although there are changes in the hypothalamic pituitary axis in terms of release of FSH and LH resulting in anovulation in women on oral contraceptives, the evidence to date does not support a cause and effect phenomenon. On the basis of both epidemiologic as well as biochemical studies, the etiology of secondary amenorrhea is diverse. This serves only to indicate that amenorrhea is a symptom, not a diagnosis. It appears at the present time that amenorrhea following the use of oral contraceptives should indicate only the preceding temporal use of exogenous steroids without implication as to a cause of the amenorrhea. Investigation should be aimed at determining the underlying cause of the amenorrhea.

Amenorrhea↗
PubMed1981

Management of pelvic endometriosis with low-dose danazol.

Thirty-eight women with pelvic endometriosis diagnosed by laparotomy or laparoscopy were enrolled in a double-blind study utilizing danazol. Danazol was administered for 6 months in four doses schedules: 600, 400, 200, and 100 mg/day. At the completion of 6 months of therapy, repeat laparoscopy was performed and 71% of the women were found to have improvement of pelvic endometriosis. Minimal and moderate pelvic endometriosis appeared to respond well to doses of danazol of less than 400 mg/day, whereas severe endometriosis appeared to be best treated with danazol doses of greater than 400 mg/day. Symptomatic relief of pain, dysmenorrhea, and dyspareunia occurred in 89% of the women. The over-all pregnancy rate in women attempting conception was 28% (8 of 28). Fifty-four per cent of the women had recurrence of symptoms within 1 year of discontinuation of danazol.

Adult↗
PubMed1980

Prolactin-secreting pituitary adenomas: serum and tissue prolactin levels with ultrastructural correlation.

Adenomatous tissue was obtained from 10 women with evidence of prolactin-secreting pituitary adenoma at the time of transsphenoidal removal of the tumor. Tissue levels of prolactin (hPRL) were estimated after extraction and were compared to preoperative peripheral serum levels of hPRL. No correlation was found between the tissue and serum concentrations of hPRL, although high levels of hPRL were found in the tissue extracts. Electron microscopy confirmed active secretion of the individual cells, and the ultrastructural findings were compatible with prolactin-secreting adenomas. Associated with the active secretion was extensive exocytosis of the secretory granules away from the capillary wall. These findings suggest that, although active secretion of hPRL is occurring, large amounts of secreted hPRL are not available for immediate uptake into the capillary plexus; thus a slow absorption of hPRL could be taking place from the adenomatous tissue. These data could explain the failure of provocative tests of hPRL stimulation and inhibition to unequivocally characterize an adenoma in an individual with elevated serum levels of hPRL.

Adenoma↗
PubMed1980

Physiology of prolactin.

The principal physiologic effect of PRL in human females is the initiation of lactation. The cellular events leading to actual secretion of breast milk are reasonably well defined in the experimental animal. Other than the direct effects on breast tissue in pregnancy, prolactin's role at puberty, during the menstrual cycle, and in pregnancy is poorly defined at present. Although there are large quantities of PRL in amniotic fluid the physiologic role is unknown. There is evidence for an osmoregulatory role of PRL in the amniotic fluid, and a very questionable role for PRL in fetal lung maturation. Overall, much more investigation is warranted to define more clearly the effects of PRL in reproductive physiology.

Amniotic Fluid↗
PubMed1978

Symptomatic pituitary tumor enlargement after induced pregnancy. Case report.

A case is presented and 11 others are reviewed in which symptomatic pituitary tumor enlargement occurred during pregnancies that resulted from induced ovulation. The syndrome is usually characterized by headache and visual disturbances with bitemporal visual field abnormalities, but may present with ocular muscle palsies. The cases are divided into two groups. The patients in one group had a shorter duration of amenorrhea (3.8 years), developed symptoms before the 14th week of pregnancy, and were usually treated by tumor removal. Patients in the second group had a longer period of amenorrhea (10.2 years), developed symptoms after the 24th week of pregnancy, and their symptoms regressed with delivery of the infant. Tumor removal or termination of the pregnancy both resulted in resolution of symptoms. All pregnancies resulted in normal infants. This series provides guidelines for management of future cases.

Adenoma, Chromophobe↗
PubMed1978

Management of the Menopause.

Menopause is merely a clinically discernible clue symbolic of the multitude of changes preceding or following the cessation of menses by many years. Because of the time span involved, separating changes observed in the menopausal transition from other age-related maturational events presents serious methodologic problems. Of the host of psychologic and psychosomatic symptoms, only hot flushes and associated sweats occur more frequently in this epoch, while an interplay between hormonal and age-related maturational events presents serious methodologic problems. Of the host of psychologic and psychosomatic symptoms, only hot flushes and associated sweats occur more frequently in this epoch, while an interplay between hormonal and age-related effects is assumed in atrophic changes involving the genitourinary organs. The relation between menopause and osteoporosis is suggestive but by no means proven, as is the risk for cardiovascular disease. Empiric evidence points to the usefullness of estrogen for the management of vasomotor instability, the symptoms associated with atrophy of the genitourinary tract, and in the prophylaxis of osteoporosis, but not in the treatment of anxiety, depression, and other psychiatric disorders.

Adult↗